van Dam Lisette F, van den Hout Wilbert B, Gautam Gargi, Dronkers Charlotte E A, Ghanima Waleed, Gleditsch Jostein, von Heijne Anders, Hofstee Herman M A, Hovens Marcel M C, Huisman Menno V, Kolman Stan, Mairuhu Albert T A, Nijkeuter Mathilde, van de Ree Marcel A, van Rooden Cornelis J, Westerbeek Robin E, Westerink Jan, Westerlund Eli, Kroft Lucia J M, Klok Frederikus A
Department of Thrombosis and Hemostasis and.
Department of Biomedical Data Sciences-Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Blood Adv. 2021 Mar 9;5(5):1369-1378. doi: 10.1182/bloodadvances.2020003849.
The diagnostic workup of recurrent ipsilateral deep vein thrombosis (DVT) using compression ultrasonography (CUS) can be complicated by persistent intravascular abnormalities after a previous DVT. We showed that magnetic resonance direct thrombus imaging (MRDTI) can exclude recurrent ipsilateral DVT. However, it is unknown whether the application of MRDTI in daily clinical practice is cost effective. The aim of this study was to evaluate the cost effectiveness of MRDTI-based diagnosis for suspected recurrent ipsilateral DVT during first year of treatment and follow-up in the Dutch health care setting. Patient-level data of the Theia study (NCT02262052) were analyzed in 10 diagnostic scenarios, including a clinical decision rule and D-dimer test and imaging with CUS and/or MRDTI. The total costs of diagnostic tests and treatment during 1-year follow-up, including costs of false-positive and false-negative diagnoses, were compared and related to the associated mortality. The 1-year health care costs with MRDTI (range, €1219-1296) were generally lower than strategies without MRDTI (range, €1278-1529). This was because of superior specificity, despite higher initial diagnostic costs. Diagnostic strategies including CUS alone and CUS followed by MRDTI in case of an inconclusive CUS were potential optimal cost-effective strategies, with estimated average costs of €1529 and €1263 per patient and predicted mortality of 1 per 737 patients and 1 per 609 patients, respectively. Our model shows that diagnostic strategies with MRDTI for suspected recurrent ipsilateral DVT have generally lower 1-year health care costs than strategies without MRDTI. Therefore, compared with CUS alone, applying MRDTI did not increase health care costs.
使用压迫超声检查（CUS）对复发性同侧深静脉血栓形成（DVT）进行诊断检查时，先前DVT后持续存在的血管内异常可能会使检查变得复杂。我们发现磁共振直接血栓成像（MRDTI）可以排除复发性同侧DVT。然而，MRDTI在日常临床实践中的应用是否具有成本效益尚不清楚。本研究的目的是评估在荷兰医疗保健环境中，基于MRDTI诊断疑似复发性同侧DVT在治疗和随访的第一年的成本效益。在10种诊断方案中分析了Theia研究（NCT02262052）的患者水平数据，包括临床决策规则、D-二聚体检测以及使用CUS和/或MRDTI进行成像。比较了1年随访期间诊断检查和治疗的总成本，包括假阳性和假阴性诊断的成本，并将其与相关死亡率相关联。使用MRDTI的1年医疗保健成本（范围为1219 - 1296欧元）通常低于不使用MRDTI的策略（范围为1278 - 1529欧元）。这是因为尽管初始诊断成本较高，但特异性更高。仅包括CUS以及在CUS结果不确定时随后进行MRDTI的诊断策略是潜在的最佳成本效益策略，估计每位患者的平均成本分别为1529欧元和1263欧元，预测死亡率分别为每737名患者1例和每609名患者1例。我们的模型表明，对于疑似复发性同侧DVT，采用MRDTI的诊断策略通常比不采用MRDTI的策略具有更低的1年医疗保健成本。因此，与单独使用CUS相比，应用MRDTI不会增加医疗保健成本。
